Neuralgia of the trigeminal nerve

Neuralgia of the trigeminal nerve (painful tick) - paroxysms of severe acute shooting facial pain due to the defeat of the V pair of cranial nerves.

The diagnosis is based on the clinical picture. Conventional treatment of neuralgia of the trigeminal nerve with carbamazepine or gabapentin; sometimes - operation.

Causes of trigeminal neuralgia

Neuralgia of the trigeminal nerve develops as a result of pathological pulsations of the intracranial arterial or venous (less often) loop, which compresses the spine of the V pair at the entrance to the brain stem. Sometimes the disease develops due to multiple sclerosis. Neuralgia of the trigeminal nerve often affects adults, especially the elderly.

[1], [2], [3], [4]

Symptoms of trigeminal neuralgia

Pain shooting, painful, often disabling occurs in the zone of innervation of one or more branches of the trigeminal nerve (more often - the maxillary) and lasts from seconds to 2 minutes. Pain often provokes touching the trigger points on the face or movements (for example, chewing, brushing teeth).

Symptoms of neuralgia of the trigeminal nerve pathognomonic. Postherpetic pains are characterized by resistance, typical of the previous rash, scars and the tendency to defeat the first branch. With migraine, facial pain is usually more prolonged and often pulsates. Neurologic examination of pathology does not reveal. The appearance of a neurological deficit indicates an alternative cause of pain (for example, a tumor, a plaque with multiple sclerosis, vascular malformation, other lesions that lead to compression of the nerve or pathways in the brainstem, stroke). The damage to the brainstem is indicated by impaired sensitivity in the zone of innervation of the V pair, corneal reflex and motor function. The loss of pain and temperature sensitivity, loss of the corneal reflex with preservation of the motor function presupposes a medullary lesion. V deficiency is possible with Sjogren's syndrome or rheumatoid arthritis, but only with a sensory deficit involving the nose and the area around the mouth.

Treatment of trigeminal neuralgia

With a prolonged course of neuralgia of the trigeminal nerve, carbamazepine is usually effective 200 mg orally 3-4 times / day; After 2 weeks of treatment and then every 3-6 months, liver function and hematopoiesis should be checked. If carbamazepine is ineffective or has a side effect, gabapentin is prescribed 300-900 mg orally 3 times / day, phenytoin 100-200 mg orally 2-3 times / day, baclofen 10-30 mg orally 3 times / day or amitriptyline 25-200 mg orally before bedtime. Peripheral blockade gives only temporary relief.

If, in spite of the measures listed, severe pain persists, consideration should be given to the possibility of neuromuscular treatment of trigeminal neuralgia. The effectiveness of such methods of treating trigeminal neuralgia is temporary, and improvement can result in relapses of persistent pain, even worse than those about which surgery was performed. With the craniectomy of the posterior cranial fossa, a small gasket can be used to insulate the spine of the trigeminal nerve from the pulsating vascular loop. Probably radiosurgical intersection of the proximal segment of the trigeminal nerve with a gamma knife. There are methods of electrolytic and chemical destruction, as well as balloon compression of the ganglion of the trigeminal nerve (gasser node) by percutaneous stereotactic puncture. A measure of desperation is the intersection of the fibers of the trigeminal nerve between the gasseric node and the brain stem.